Treating Cancer: Integrative Medicine
For a new book, Dr. Weil and Donald I. Abrams, M.D., the former director of Clinical Programs at the University of California, San Francisco Osher Center for Integrative Medicine, assembled a team of experts to assess what the emerging field of integrative oncology has to offer cancer patients.
Published by Oxford University Press, Integrative Oncology is aimed at health professionals but can be understood by cancer patients and their families as well as by health-conscious individuals concerned with cancer prevention. The book is the first in a planned series on integrative medicine's role in various medical specialties including psychiatry, rheumatology, asthma and immunology, pediatrics, women's health and others.
Here, in the first of a two-part interview, Dr. Abrams talks about his practice of integrative oncology and how integrative medicine can enhance cancer treatment. In a second article, he will discuss how integrative medicine fits into cancer prevention.
What role does integrative medicine (IM) play in cancer treatment?
The field of oncology (cancer treatment) is fairly new but has exploded in recent years and become more and more specialized. A patient may need a surgical oncologist to remove a tumor, a radiation oncologist for radiation therapy and a medical oncologist to provide chemotherapy, hormone therapy and targeted cancer therapy (drugs that block cancer spread). Some oncologists now specialize in treating only certain types of cancer, such as colorectal or pancreatic. This increasing specialization benefits patients in that they get care from physicians who are experts in their specific disease, but in the process, the specialist may tend to see only the tumor and not the patient. Integrative oncology looks at the whole patient, body, mind and spirit.
I tell my patients that I think of cancer as a weed. Modern western oncology is focused on destroying the weed while integrative oncology concentrates on the soil the weed grows in and on making the soil as inhospitable as possible to the growth and spread of the weed.
We also recognize that many cancer patients are people who have been highly functional and in control of their lives. A cancer diagnosis takes away that control and puts them at the mercy of doctors. In my practice, I try to return to the patient some sense of control by giving them things they can do to take their lives back into their own hands. At the same time I'm also trying to decrease ongoing inflammation in the body, which is at the root of many chronic diseases, and to enlist the body's innate immunity to fight against the cancer as well as decreasing stress and increasing hope.
Are there dietary changes that can help patients fight cancer?
The one thing we know for sure about diet is that obesity increases the risk of a number of different types of cancer. With hormonally driven cancers (such as breast cancer) obese patients have a worse prognosis than those with a healthy body mass index. So it is important for some patients to improve their nutritional status and decrease their weight. The most useful strategy is to eat a plant-based diet focusing on a wide variety of colored fruits and vegetables. Cruciferous vegetables such as broccoli, cauliflower and cabbage contain a cancer-preventing compound so potent that is being investigated as a chemotherapy agent. Berries are rich in beneficial phytonutrients and antioxidants. Overall, a diet that emphasizes fruits and vegetables, whole grains, nuts, cold water fish that provide omega-3 fatty acids (fish eaters have a reduced risk of cancer) is the best nutritional strategy.
At the same time, we recommend decreasing your intake of animal fats in general and red meat and dairy products in particular to control cancer-promoting inflammation in the body. I personally believe that refined sugar and carbohydrates are not beneficial for individuals living with cancer because of their effect on insulin production and insulin-like growth factors, which promote inflammation and are also associated with cancer cell division.
I appreciate the fact that organic fruits and vegetables are expensive, but they are the best choices for cancer patients, not just because they're grown without pesticides and other agricultural chemicals but because plants grown outdoors organically need to protect themselves from other plants, predators (insects, birds and animals) and the sun. Organically grown plants do this by producing more intense protective chemicals, known as phytonutrients, which are beneficial to us.
I also recommend seasoning food with ginger, garlic, onions, turmeric, drinking green tea, all of which have anti-inflammatory effects. If you drink alcohol, stick to red wine. Excessive alcohol consumption is a cancer risk, men who drink alcohol should limit themselves to a maximum of two drinks daily and women to a maximum of one. For women at risk for breast cancer, one drink a week is safest.
What about IM strategies to counter the side effects of conventional cancer treatment?
I refer my patients to Traditional Chinese Medicine practitioners on the staff at the Osher Center. I believe that cancer patients treated concurrently with acupuncture tend to do better. In fact, the National Institutes of Health had a consensus conference on acupuncture in 1997 and found that it was useful in treating side effects of chemotherapy, including chemotherapy associated nausea and vomiting. I think it may also be useful for increasing energy, decreasing dry mouth and relieving hormonally induced hot flashes. Traditional Chinese Medicine is all about expelling evil and supporting good. Modern western medicine is mainly about expelling evil. I think my role as an integrative oncologist is to support the good as well as expelling the evil.
You wrote about the uses of medical marijuana in cancer treatment and prevention. What role do you see it playing in the future?
I've been an oncologist for almost 30 years so my career has spanned the yin and yang of society's acceptance and rejection of marijuana for medical purposes. We know that cannabis is useful for treating nausea, appetite loss, pain and insomnia that can be side effects of chemotherapy or cancer itself. We now also appreciate that some components of cannabis may have significant anti-cancer effects. I wrote a chapter on cannabinoids and cancer in integrative oncology with Manuel Guzman, a professor of biochemistry and molecular biology in Spain who has done a lot of work in this area. Researchers are now looking at the impact of cannabinoids on cancer. I wouldn't be surprised to see an impact on treatment.
Tell us about the importance of mind/body approaches in cancer treatment.
These approaches are vital. Patients have lost a sense of control and their bodies have been assaulted with chemotherapy and radiation. Learning mind body techniques - guided imagery, hypnosis, mindfulness, stress, reduction, yoga, T'ai chi - helps decrease stress. Many people blame the stress in their lives for the development of cancer. I don't think stress in and of itself is enough to cause cancer, but it does affect production of hormones such as epinephrine and cortisol that can depress the immune system. So, overall, stress may lead to an increased risk that cancer will spread and to shorter survival. It has been shown that women with ovarian cancer who lack a good support system have more distress and more aggressive malignancies, and this is just one example of a psychological association and a biological marker for more aggressive disease.
Read another interview with Dr. Abrams: Preventing Cancer With Integrative Medicine.